We aimed to investigate association of three DanGer Shock trial criteria [systolic blood pressure [SBP] < 100 mmHg, lactate ≥ 2.5 mmol/L, and left ventricular ejection fraction (LVEF) < 45
Cardiac sarcoidosis (CS) is an inflammatory/granulomatous disease that affects the heart and is responsible for mortality due to fatal arrhythmias or systolic heart failure. The efficacy and outcomes of cardiac resynchronization therapy (CRT) for CS remain uncertain. We retrospectively analyzed a cohort of 108 patients diagnosed with CS at Nippon Medical School Hospital and extracted 19 patients who underwent CRT implantation between 2007 and 2024 (68
Atrial fibrillation (AF) is common in patients with peripheral artery disease (PAD) and is associated with adverse cardiovascular outcomes. However, its impact on heart failure (HF)-related events after endovascular therapy (EVT) remains unclear, particularly according to baseline HF status.We retrospectively analyzed a multicenter cohort of 1585 patients with symptomatic PAD undergoing EVT. Patients were stratified according to AF and baseline HF status. The primary outcome was HF-related events over a 3-year follow-up period. Kaplan–Meier analysis and Cox proportional hazards models were used. AF was associated with a higher risk of HF-related events. At 3 years, event-free survival was lower in patients with AF than in those without AF. In patients without baseline HF, event-free survival was significantly lower in those with AF (87.9 vs. 96.8
Excessive cardiac sympathetic nerve activity significantly contributes to chronic heart failure (CHF) and lethal arrhythmias. However, reliable dynamic markers to assess sympathetic modulation are lacking in clinical practice. The T wave peak to T wave end interval (TpTe) to Q-T end interval ratio (TpTe/QTe) has been suggested as a surrogate marker for transmural dispersion of repolarization (TDR). We hypothesized that the TpTe/QTe reflects cardiac sympathetic nerve activity based on anatomical differences in the distribution and activation of cardiac sympathetic nerves. 12-lead Electrocardiograms (ECGs) were analyzed retrospectively in two cohorts without structural heart disease: (1) Exercise study; ECGs from patients who underwent treadmill or cardiopulmonary exercise testing between 2013 and 2023 were analyzed at baseline and 1-min post-maximal exercise. (2) β-stimulator infusion study; ECGs from patients who underwent catheter ablation (CA) of premature ventricular contractions (PVCs) or paroxysmal supraventricular tachycardias (PSVT) between 2017 and 2022 were analyzed at baseline and post-isoproterenol (ISO) infusion. In the exercise study, 45 patients (35.6
Lipoprotein(a) [Lp(a)] and vascular calcification have each been associated with poor outcomes in lower extremity arterial disease (LEAD). This study investigated whether elevated Lp(a) levels and severe calcification have combined prognostic value for major adverse limb events (MALE) after endovascular therapy (EVT). We retrospectively analyzed 145 patients who underwent EVT. Patients were classified according to the number of Lp(a)/ Peripheral Arterial Calcium Scoring System (PACSS) risk markers: elevated Lp(a) (≥ 30 mg/dL) and PACSS grade 4. The primary endpoint was 1-year MALE incidence. MALE occurred in 17 patients during follow-up. Patients were classified into three groups according to the number of Lp(a)/PACSS risk markers. The cumulative incidence of MALE differed significantly among the three groups (overall P = 0.032). Compared with the 0 risk-marker group, the 1 risk-marker group and the 2 risk-marker group had significantly higher risks of MALE (hazard ratio [HR], 3.175; 95
Aortic calcification detected on computed tomography (CT) is a marker of systemic atherosclerosis. Its clinical significance in predicting contrast-associated acute kidney injury (CA-AKI) after urgent coronary angiography remains unclear. A total of 140 patients (median age, 73 years [interquartile range 58–81]; female, 24.3
An anomalous aortic origin of a coronary artery (AAO-CA) is one of the leading causes of sudden cardiac death in children. This study aimed to characterize the clinical features and outcomes of AAO-CA diagnosed between 2000 and 2019 using data from a nationwide survey in Japan. We identified 106 pediatric patients with AAO-CA (71 AAO-right CA and 35 AAO-left CA cases) from 32 participating institutions, with a median age of 9.1 (4.9–13.3) years at the time of diagnosis. At diagnosis, more than half (59
Background: Takotsubo syndrome (TS), an acute stress-induced cardiomyopathy driven by catecholamine excess, shares pathophysiological features with sleep disordered breathing (SDB), yet this relationship remains unexplored. We hypothesize that SDB and sleep disruption influences TS risk and severity. Methods: We leveraged data from the Cleveland Clinic sleep cohort (1999–2021) including patients with proven TS and matched controls (1:5 ratio by age, sex, body mass index (BMI), and study year). Logistic regression models were used to assess odds of TS associated with SDB biomarkers, i.e., apnea-hypopnea index (AHI; evaluated at thresholds ≥ 5, ≥15, and ≥ 30), hypoxia (percentage of sleep time with SaO2 <90
We thank Birgün et al. for their thoughtful comments regarding our recent study on microvascular angina (MVA). In this reply, we address concerns regarding the selection of control group, medication-related confounding, and the heterogeneity of MVA endotypes. We acknowledge the limitations inherent to our retrospective case-control design while emphasizing that the observed associations between mildly elevated HbA1c, low high-density lipoprotein cholesterol, low hemoglobin levels, and MVA remained significant. We hope that these findings will stimulate further prospective investigations into the pathophysiology and clinical characteristics of MVA.
This research investigated the relationship between serum Syndecan-1 levels and myocardial fibrosis (MF) and major adverse cardiovascular events (MACEs) in elderly patients with atrial fibrillation (AF). Elderly patients with AF were divided into MF (n = 162) and N-MF (n = 89) groups. During 5-year follow-up, 78 patients with MACEs formed the MACEs group, and 173 without MACEs formed the N-MACEs group. Spearman correlation analysis was performed. Multivariate Cox regression and Kaplan–Meier curves were conducted, and ROC curves were plotted. Serum Syndecan-1 was elevated in the MF group versus the N-MF group. Serum Syndecan-1 levels in AF patients showed moderate positive correlations with both sST2 (r = 0.569) and PINP (r = 0.446). Serum Syndecan-1 showed diagnostic value for MF in patients with AF, with an AUC of 0.810. Moreover, combined detection with sST2 and PINP further achieved an AUC of 0.872. Serum Syndecan-1 levels were elevated in the MACE group compared to the N-MACEs group, and serum Syndecan-1 demonstrated discriminatory value for 5-year MACEs (AUC = 0.832). Serum Syndecan-1 (HR = 1.049) was independently associated with 5-year MACEs in AF patients. The risk associated with Syndecan-1 was more pronounced in patients with paroxysmalAF. After adjusting for sST2, NT-proBNP, LVEF, and MF, Syndecan-1 was independently associated with MACEs in patients with heart failure (P = 0.021). Elevated serum Syndecan-1 levels are associated with MF and MACEs in AF patients, suggesting its potential value as a biomarker for discriminating MF and MACEs in AF patients.
Functional tricuspid regurgitation (FTR) is increasingly prevalent in aging populations with heart failure (HF) and has been associated with adverse outcomes. However, the clinical characteristics and prognosis of patients with isolated severe FTR remain poorly defined. We retrospectively reviewed 108,513 consecutive transthoracic echocardiographic examinations performed between June 2013 and March 2025. Isolated severe FTR was defined as severe FTR without significant left-sided valvular disease and preserved left ventricular ejection fraction (LVEF ≥ 50
